Sprains and Strains
General Treatment
1. First-aid treatment for sprain and strain injuries is summarized by the acronym RISE (rehabilitation, ice, support, and elevation.)
a. Rehabilitation: Rehabilitation replaces the outdated advice to put the joint at rest. Instead, early mobility, light touch weight bearing, and range of motion activities promote earlier recovery from sprain.
b. Ice: Ice reduces swelling and eases pain. Make sure to provide a layer of cloth between skin and ice to prevent freezing the underlying tissue. For ice or cold therapy to be effective, apply ice early and for up to 20 minutes at least three or four times a day, for the first 72 hours after injury.
c. Support: More helpful than compression is support of the injured tissues, ideally with an air splint type device or with taping (see Chapter 23 for taping information).
d. Elevation: Elevate the injured joint above the level of the heart as often as possible to reduce swelling.
2. Administer an oral nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen 600 mg q6h, to reduce pain and inflammation.
Disorders
Signs and Symptoms
1. Ankle sprain: The most commonly injured ligaments (anterior and posterior talofibular and calcaneofibular ligaments) are on the lateral aspect of the joint (Fig. 21-1).
FIGURE 21-1 Ligament complexes of the ankle.
2. A syndesmosis injury, or “high ankle sprain,” may occur. Tenderness occurs over the anterior tibiofibular and deltoid ligaments. A positive squeeze test, in which pain radiates through the interosseous membrane with compression of the tibia against the fibula, exists. The fibula may be fractured. Symptoms of proximal fibular fracture include associated proximal fibular tenderness or crepitus.
3. A midfoot sprain can occur with associated tarsometatarsal fracture (Lisfranc’s injury). These injuries present as severe pain and marked swelling along the entire midfoot. This can be a problematic injury associated with compartment syndrome of the foot. Keep the patient non–weight bearing with elevation. Use ice if available. Evacuate the patient for definitive orthopedic reduction.
4. Differentiate ankle sprain from fracture (see Chapter 18).
Ruptured Achilles Tendon
Signs and Symptoms
1. An audible “pop,” with a sensation similar to being kicked in the calf
2. Difficulty plantar flexing the foot, although the plantaris muscle can plantar flex the foot as well. The only reliable sign is Thompson’s test
3. Thompson’s test: The patient is placed in a prone position with the foot hanging free. If there is no plantar flexion of the foot as the calf is squeezed, Thompson’s test is positive.
4. Swelling of the distal calf
5. Sometimes, a palpable defect in the tendon 2 to 6 cm (
to 
inches) proximal to its insertion can be appreciated within the first hour. After that, if there is significant bleeding, the defect can be more difficult to detect
